Tonsillectomy

Tonsillectomy is a surgical procedure in which both palatine tonsils are fully removed from the back of the throat. The procedure is mainly performed for recurrent throat infections and obstructive sleep apnea (OSA). For those with frequent throat infections, surgery results in fewer sore throats in the following one to two years, but unclear long term benefits. In children with OSA it results in improved quality of life.Clinicians may recommend tonsillectomy for recurrent throat infection with a frequency of at least 7 episodes in the past year or at least 5 episodes per year for 2 years or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat and one or more of the following: temperature >38.3 °C, cervical adenopathy, tonsillar exudates, or positive test for Group A Beta- hemolytic strep.Right now, doctors, a lot of times, are forced to make decisions based on the fee payment schedule that's out there. So if they're looking and -- and you come in and you've got a bad sore throat, or your child has a bad sore throat, or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, 'You know what? I make a lot more money if I take this kid's tonsils out.' Now, that may be the right thing to do. But I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change -- maybe they have allergies. Maybe they have something else that would make a difference. Tonsillectomy is a surgical procedure in which both palatine tonsils are fully removed from the back of the throat. The procedure is mainly performed for recurrent throat infections and obstructive sleep apnea (OSA). For those with frequent throat infections, surgery results in fewer sore throats in the following one to two years, but unclear long term benefits. In children with OSA it results in improved quality of life. While generally safe, complications may include bleeding, vomiting, dehydration, trouble eating, and trouble talking. Throat pain typically lasts about one to two weeks after surgery. Bleeding occurs in about 1% within the first day and another 2% after that. Death occurs as a result in 1 out of between 2,360 and 56,000 procedures. Tonsillectomy does not appear to affect long term immune function. Following the surgery ibuprofen and paracetamol (acetaminophen) may be used to treat postoperative pain. The surgery is often done using metal instruments or electrocautery. The adenoid may also be removed in which case it is known as an 'adenotonsillectomy'. The partial removal of the tonsils is called a 'tonsillotomy', which may be preferred in cases of OSA. The surgery has been described since at least as early as 50 AD by Celsus. In the United States, as of 2010, tonsillectomy is performed less frequently than in the 1970s although it remains the second most common outpatient surgical procedure in children. The typical cost when done as an inpatient in the United States is US$4,400 as of 2013. There is some controversy as of 2019 as to when the surgery should be used. Tonsillectomy is mainly undertaken for sleep apnea and recurrent or chronic tonsillitis. It is also carried out for peritonsillar abscess, periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA), guttate psoriasis, nasal airway obstruction, tonsil cancer and diphtheria carrier state. For children, tonsillectomy is usually combined with the removal of the adenoid. Surgery is not recommended for those with fewer than 7 throat infections in the last year, fewer than 5 each year for the last 2 years, or fewer than 3 each year for 3 years. Severely affected children who undergo surgery on average have one fewer sore throat per year in the subsequent one or two years, compared to those who do not. Specifically one review found a decrease from 3.6 to 3.0 episodes in the year following surgery. In less severely affected children, surgery results in an increase, rather than a decrease of sore throats when the sore throat directly following surgery is included. Surgery results in a reduction in school absence in the year after surgery, but the strength of evidence is low. Surgery does not result in an improvement in quality of life. Benefits of surgery do not persist over time. Those with frequent throat infections often improve over a year without surgery. Evidence in adults is unclear. The American Academy of Otolaryngology & Head and Neck Surgery (AAO-HNS) guideline in 2011 states tonsillectomy indicated the following: